Abstract
PurposeWorking in conditions with daily exposure to organic solvents for many years can result in a disease known as chronic solvent-induced encephalopathy (CSE). The aims for this study were to describe the neuropsychological course of CSE after first diagnosis and to detect prognostic factors for neuropsychological impairment after diagnosis.MethodsThis prospective study follows a Dutch cohort of CSE patients who were first diagnosed between 2001 and 2011 and underwent a second neuropsychological assessment 1.5–2 years later. Cognitive subdomains were assessed and an overall cognitive impairment score was calculated. Paired t tests and multivariate linear regression analyses were performed to describe the neuropsychological course and to obtain prognostic factors for the neuropsychological functioning at follow-up.ResultsThere was a significant improvement on neuropsychological subdomains at follow-up, with effect sizes between small and medium (Cohen’s d 0.27–0.54) and a significant overall improvement of neuropsychological impairment with a medium effect size (Cohen’s d 0.56). Prognostic variables for more neuropsychological impairment at follow-up were a higher level of neuropsychological impairment at diagnosis and having a comorbid diagnosis of a psychiatric disorder at diagnosis.ConclusionsResults are in line with previous research on the course of CSE, stating that CSE is a non-progressive disease after cessation of exposure. However, during follow-up the percentage patients with permanent work disability pension increased from 14 to 37%. Preventive action is needed in countries where exposure to organic solvents is still high to prevent new cases of CSE.
Highlights
Organic solvents may cause harm to the nervous system (White and Proctor 1997) by affecting a range of neuronal processes at different levels: changes in ion channel receptors, cellular responses, tissue responses, changes in brain regions and in cognitive processes and behaviour (Bushnell et al 2010; van Thriel 2015; Sainio 2015)
A small subsample of workers who are exposed to organic solvents for a long time—e.g. daily exposure for 5 years or more—have been found to develop a syndrome called chronic solvent-induced encephalopathy (CSE)
From 2001 to 2011, 1,987 patients have been referred to the Solvent Teams for a first diagnostic evaluation for chronic solvent exposure-related health complaints
Summary
Organic solvents may cause harm to the nervous system (White and Proctor 1997) by affecting a range of neuronal processes at different levels: changes in ion channel receptors, cellular responses, tissue responses, changes in brain regions and in cognitive processes and behaviour (Bushnell et al 2010; van Thriel 2015; Sainio 2015). A small subsample of workers who are exposed to organic solvents for a long time—e.g. daily exposure for 5 years or more—have been found to develop a syndrome called chronic solvent-induced encephalopathy (CSE). International diagnostic criteria for this syndrome have been described by the World Health Organization (1985), and subsequently refined by a working group in Raleigh (Baker and Seppäläinen 1986), the European Union (European Commission 2009) and a neuropsychological consensus group (van Valen et al 2012). To describe possible selection bias, the study group is compared to the ‘lost to follow-up’ group and the ‘group with below cut-off performance validity on the follow-up assessment’ on demographic characteristics, neuropsychological and psychiatric functioning at first diagnostic assessment, using oneway ANOVA and post hoc tests (LSD correction) or Kruskal–Wallis tests for non-parametric variables. For the identification of possible prognostic factors a linear regression analysis is performed, with the total neuropsychological impairment score at follow-up as the dependent variable
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